IMPROVED LEFT ATRIAL TRANSPORT AND FUNCTION WITH ORTHOTOPIC HEART-TRANSPLANTATION BY BICAVAL AND PULMONARY VENOUS ANASTOMOSES

被引：22

作者：

FREIMARK, D

CZER, LSC

ALEKSIC, I

BARTHOLD, C

ADMON, D

TRENTO, A

BLANCHE, C

VALENZA, M

SIEGEL, RJ

机构：

[1] CEDARS SINAI MED CTR,DIV CARDIOTHORAC SURG,LOS ANGELES,CA 90048

[2] CEDARS SINAI MED CTR,DIV CARDIOL,LOS ANGELES,CA 90048

[3] UNIV CALIF LOS ANGELES,SCH MED,LOS ANGELES,CA

来源：

AMERICAN HEART JOURNAL | 1995年 / 130卷 / 01期

关键词：

D O I：

10.1016/0002-8703(95)90246-5

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Orthotopic heart transplantation (OHT) with bicaval and pulmonary venous anastomoses avoids the large atrial anastomoses of the standard biatrial technique. To determine whether the bicaval technique improves atrial performance, we used Doppler echocardiography to study 13 patients with bicaval OHT, 15 with biatrial OHT, and 8 normal subjects. All were in sinus rhythm and free of rejection. Left atrial size, transmitral (M) and late diastolic (A) mitral flow velocity integrals were measured. Atrial transport (A/M, %) and atrial ejection force (kilodynes, calculated from peak A-wave velocity and mitral orifice area) were assessed. Left atrial dimensions in the bicaval (4.3 +/- 0.5 cm) and biatrial groups (4.9 +/- 0.9 cm) were larger than in controls (3.3 +/- 0.8 cm, p < 0.05). Left atrial transport (37% +/- 12% and 35% +/- 12%) and ejection force (14.1 +/- 6.9 kdyne and 10.2 +/- 7.8 kdyne) were similar in the bicaval group and controls (p not significant) but were significantly lower in the biatrial group (20% +/- 19% and 3.6 +/- 4.0 kdynes, p < 0.05). The bicaval and pulmonary venous technique of OHT produces more physiologic atrial function compared with the biatrial technique as evidenced by greater atrial ejection force and more normal atrial transport.

引用

页码：121 / 126

页数：6

共 24 条

[1]

Lower, Shumway, Studies on the orthotopic homotransplantation of the canine heart, Surg Form, 2, pp. 265-284, (1960)

[2]

Angermann, Spes, Tammen, Stempfle, Schutz, Kemkes, Theisen, Anatomic characteristics and valvular function of the transplanted heart: transthoracic versus transesophageal echocardiographic findings, J Heart Transplant, 9, pp. 331-338, (1990)

[3]

Heinz, Ohner, Laufer, Gossinger, Gasic, Lackovics, Demographic and perioperative factors associated with initial and prolonged sinus node dysfunction after OHT, Transplantation, 51, pp. 1217-1232, (1991)

[4]

Triposkiadis, Starling, Haas, Sparks, Myerowitz, Boudoulas, Timing of recipient atrial contraction: a major determinant of transmitral diastolic flow in orthotopic cardiac transplantation, Am Heart J, 126, pp. 1175-1181, (1993)

[5]

Dreyfus, Jebara, Mihaileanu, Carpentier, Total orthotopic heart transplantation: an alternative to the standard technique, Ann Thorac Surg, 52, pp. 1181-1184, (1991)

[6]

Czer, Trento, Blanche, Barath, Admon, Harasty, DeRobertis, Matloff, Orthotopic heart transplantation: clinical experience with a new technique, J Am Coll Cardiol, 21, (1993)

[7]

Blanche, Valenza, Czer, Barath, Admon, Harasty, Utley, Freimark, Aleksic, Matloff, Trento, Orthotopic heart transplantation with bicaval and pulmonary venous anastomoses, The Annals of Thoracic Surgery, 58, pp. 1505-1509, (1994)

[8]

Yoshida, Yoshikawa, Shakudo, Akasaka, Jyo, Takao, Shiratori, Koizumi, Okumachi, Kato, Fukaya, Color Doppler evaluation of valvular regurgitation in normal subjects, Circulation, 78, pp. 840-847, (1988)

[9]

Billingham, Cary, Hammond, Kemnitz, Marboe, McCallister, Snovar, Winter, Zerbe, A working formulation for standardization of the nomenclature in the diagnosis of heart and lung rejection: heart rejection study group, J Heart Transplant, 9, pp. 587-593, (1990)

[10]

Hammond, Yowell, Nunoda, Menlove, Renlund, Bristow, Gay, Jones, O'Connell, Vascular (humoral) rejection in heart transplantation: pathologic observations and clinical implications, J Heart Transplant, 8, pp. 430-443, (1989)

← 1 2 3 →